Provider Demographics
NPI:1053781278
Name:MUELLER, KATIE TERESE (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:TERESE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 SEARLE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2868
Mailing Address - Country:US
Mailing Address - Phone:309-824-0727
Mailing Address - Fax:
Practice Address - Street 1:1606 HUNT DR STE 1A
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6185
Practice Address - Country:US
Practice Address - Phone:309-451-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist